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Keywords

job satisfaction, outcomes, physicians

 

Authors

  1. Williams, Eric S.
  2. Skinner, Asheley Cockrell

Abstract

The decline in physician job satisfaction is well documented, but its impact on physicians and patients is not. This article reviews 44 articles that address these impacts. Four findings emerge from this study along with recommendations for improving the measurement and management of job satisfaction.

 

At present, our health care system consists of a variety of actors and organizations embedded in a complex system of tenuous, changing relationships that, sometimes, defy understanding. Despite this, the physician-patient interaction remains the key relationship in our system. To this relationship, physicians bring their extensive training, professional knowledge, and hard-won experience. However, being human, physicians may also bring into a clinical encounter their satisfaction or dissatisfaction with their work. While professional ethics circumscribe some of the negative effects of job dissatisfaction, they cannot entirely prevent or control its expression. In recent years a literature has developed looking at the effects that physician work satisfaction and dissatisfaction may have on various physician and patient outcomes. However, to date, this literature has not been systematically reviewed and its lessons extracted. Our task is to perform this review.

 

The most compelling reasons to perform this review lie in the decline of job satisfaction among physicians and the impact that this change may have on physicians, patients, and health care organizations. An example of the magnitude of this decline can be seen in three studies representative of this trend. Typical of the 1970s, Mechanic1 found 95 percent of physicians in large group practices were satisfied with their jobs. More recent work, as exemplified by Skolnik, Smith, and Diamond,2 documents a decrease in satisfaction in their finding that only 65 percent of their family practitioner respondents were satisfied. This finding is reinforced by a 2002 Kaiser Family Foundation Poll reporting that 87 percent of respondent physicians agreed that the overall morale of physicians has dropped in the last five years. Furthermore, 58 percent said that their own enthusiasm for practicing medicine has declined in last five years.3 While this decline should be of concern, the potential impacts of the decline should cause even more concern. For physicians, increases in dissatisfaction have been linked with higher levels of burnout,4 mental health problems,5 riskier prescribing profiles,6 and suicide.7 For patients, physician dissatisfaction has been associated with lower levels of compliance with medical treatments8 and patient dissatisfaction.9 For health care organizations, the cost can be counted in finding replacements for departing clinicians. Buchbinder and colleagues estimated that the cost of primary care physician turnover ranged from $236,383 for a family practitioner to $264,345 for a general pediatrician.10 Taken together, these findings suggest that dissatisfaction has significant costs not only to physicians, but also to their patients, health care organizations, and society as a whole.